Outras apresentações
O Cryptosporidium pode causar doença crônica intratável e que implica risco de vida em pessoas com deficiência na função das células T, particularmente aquelas com imunodeficiências primárias nas células T, infecção pelo vírus da imunodeficiência humana (HIV) avançada, linfoma ou leucemia (especialmente crianças).[1]Hunter PR, Nichols G. Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev. 2002 Jan;15(1):145-54.
http://cmr.asm.org/cgi/content/full/15/1/145
http://www.ncbi.nlm.nih.gov/pubmed/11781272?tool=bestpractice.com
Todo o trato gastrointestinal, incluindo a vesícula biliar e o ducto pancreático, pode ser afetado, o que pode causar pancreatite, colecistite, colangite esclerosante e, raramente, cirrose biliar consequente.[1]Hunter PR, Nichols G. Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev. 2002 Jan;15(1):145-54.
http://cmr.asm.org/cgi/content/full/15/1/145
http://www.ncbi.nlm.nih.gov/pubmed/11781272?tool=bestpractice.com
O comprometimento traqueobrônquico é incomum, mas pode ocorrer; a sinusite também tem sido descrita nesses grupos. A criptosporidiose em um paciente com infecção por HIV avançada raramente pode se apresentar como pneumorretroperitôneo como resultado da pneumatose cistoide intestinal, na qual ocorrem cistos com gás na parede intestinal que podem se romper.[1]Hunter PR, Nichols G. Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev. 2002 Jan;15(1):145-54.
http://cmr.asm.org/cgi/content/full/15/1/145
http://www.ncbi.nlm.nih.gov/pubmed/11781272?tool=bestpractice.com
Há também portadores assintomáticos, pelo menos entre crianças pequenas, incluindo aquelas em países industrializados.[12]Pettoello-Mantovani M, Di Martino L, Dettori G, et al. Asymptomatic carriage of intestinal Cryptosporidium immunocompetent and immunodeficient children: a prospective study. Pediatr Infect Dis J. 1995 Dec;14(12):1042-7.
http://www.ncbi.nlm.nih.gov/pubmed/8745015?tool=bestpractice.com
[13]Isaacs D, Hunt GH, Phillpis AD, et al. Cryptosporidiosis in immunocompentent children. J Clin Pathol. 1985 Jan;38(1):76-81.
http://www.ncbi.nlm.nih.gov/pubmed/4038504?tool=bestpractice.com
[14]Baxby D, Hart CA. The incidence of cryptosporidiosis: a two-year prospective survey in a children's hospital. J Hyg (Lond). 1986 Feb;96(1):107-11.
http://www.ncbi.nlm.nih.gov/pubmed/3950390?tool=bestpractice.com
[15]Addiss DG, Stewart JM, Finton RJ, et al. Giardia lamblia and Cryptosporidium infections in child day-care centers in Fulton County, Georgia. Pediatr Infect Dis J. 1991 Dec;10(12):907-11.
http://www.ncbi.nlm.nih.gov/pubmed/1766706?tool=bestpractice.com
[16]García-Rodríguez JA, Martín-Sánchez AM, Canut Blasco A, et al. The prevalence of Cryptosporidium species in children in day care centres and primary schools in Salamanca (Spain): an epidemiological study. Eur J Epidemiol. 1990 Dec;6(4):432-5.
http://www.ncbi.nlm.nih.gov/pubmed/2091947?tool=bestpractice.com
[17]Davies AP, Campbell B, Evans MR, et al. Asymptomatic carriage of protozoan parasites in children in day care centers in the United Kingdom. Pediatr Infect Dis J. 2009 Sep;28(9):838-40.
http://www.ncbi.nlm.nih.gov/pubmed/19684527?tool=bestpractice.com
[18]Lacroix C, Berthier M, Agius G, et al. Cryptosporidium oocysts in immunocompetent children: epidemiologic investigations in the day-care centers of Poitiers, France. Eur J Epidemiol. 1987 Dec;3(4):381-5.
http://www.ncbi.nlm.nih.gov/pubmed/2826221?tool=bestpractice.com
Nos países de renda baixa a média, estudos em grande escala demonstraram que a infecção por Cryptosporidium causa impactos duradouros na saúde e elevada mortalidade em bebês e crianças pequenas desnutridas. A presença de desnutrição, o deficit estatural, a emaciação e o deficit cognitivo estão entre os impactos na África Subsaariana, na América do Sul e no Sudeste Asiático.[19]Sallon S, Deckelbaum RJ, Schmid II, et al. Cryptosporidium, malnutrition, and chronic diarrhea in children. Am J Dis Child. 1988 Mar;142(3):312-5.
http://www.ncbi.nlm.nih.gov/pubmed/3344720?tool=bestpractice.com
[20]Sarabia-Arce S, Salazar-Lindo E, Gilman RH, et al. Case-control study of Cryptosporidium parvum infection in Peruvian children hospitalized for diarrhea: possible association with malnutrition and nosocomial infection. Pediatr Infect Dis J. 1990 Sep;9(9):627-31.
http://www.ncbi.nlm.nih.gov/pubmed/2235186?tool=bestpractice.com
[21]Lima AA, Fang G, Schorling JB, et al. Persistent diarrhea in Northeast Brazil: etiologies and interactions with malnutrition. Acta Paediatr Suppl. 1992 Sep;381:39-44.
http://www.ncbi.nlm.nih.gov/pubmed/1421939?tool=bestpractice.com
[22]Mølbak K, Andersen M, Aaby P, et al. Cryptosporidium infection in infancy as a cause of malnutrition: a community study from Guinea-Bissau, west Africa. Am J Clin Nutr. 1997 Jan;65(1):149-52.
http://www.ncbi.nlm.nih.gov/pubmed/8988927?tool=bestpractice.com
[23]Checkley W, Epstein LD, Gilman RH, et al. Effects of Cryptosporidium parvum in Peruvian children: growth faltering and subsequent catch-up growth. Am J Epidemiol. 1998 Sep 1;148(5):497-506.
http://aje.oxfordjournals.org/cgi/reprint/148/5/497
http://www.ncbi.nlm.nih.gov/pubmed/9737562?tool=bestpractice.com
[24]Khalil IA, Troeger C, Rao PC, et al. Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study. Lancet Glob Health. 2018 Jul;6(7):e758-68.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005120
http://www.ncbi.nlm.nih.gov/pubmed/29903377?tool=bestpractice.com
[25]Checkley W, White AC Jr, Jaganath D, et al. A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for cryptosporidium. Lancet Infect Dis. 2015 Jan;15(1):85-94.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401121
http://www.ncbi.nlm.nih.gov/pubmed/25278220?tool=bestpractice.com
[26]Korpe PS, Valencia C, Haque R, et al. Epidemiology and risk factors for cryptosporidiosis in children from 8 low-income sites: results from the MAL-ED study. Clin Infect Dis. 2018 Nov 13;67(11):1660-9.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233690
http://www.ncbi.nlm.nih.gov/pubmed/29701852?tool=bestpractice.com